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Reasonable time frame for prn medication to be given?

Nurses   (7,528 Views | 64 Replies)
by nicegirl2 nicegirl2 (New) New

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Just because a code blue isn't announced doesn't mean there's not an emergency.

I had 2 patients the other day. I pretty much spent my entire day with the extremely critical one. I felt horrible for my other patient, but fortunately her family was understanding. I made it in her room as often as I could, but I was titrating life saving drips in the other, and transfusing blood, also trying to get them to CT while having respiratory distress.

My other patient and family were not at all aware of what was happening in my other room. I'm sure they knew I was busy, but had no idea I was trying to keep a dying, septic, man alive.

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AceOfHearts<3 specializes in Critical care.

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Just because a code blue isn't announced doesn't mean there's not an emergency.

I had 2 patients the other day. I pretty much spent my entire day with the extremely critical one. I felt horrible for my other patient, but fortunately her family was understanding. I made it in her room as often as I could, but I was titrating life saving drips in the other, and transfusing blood, also trying to get them to CT while having respiratory distress.

My other patient and family were not at all aware of what was happening in my other room. I'm sure they knew I was busy, but had no idea I was trying to keep a dying, septic, man alive.

I've had that happen too or I'm helping another nurse with a super critical patient while my 1-2 patients are very stable. I tend to explain that I'm not ignoring them, I'm helping with another very critical patient, and if they need anything to not hesitate to ring the call bell and either myself or somebody else will respond. I've always had very good reception to this with many saying they understand and received the same care when they needed it.

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Tenebrae has 8 years experience as a BSN, RN and specializes in Mental Health, Gerontology, Palliative.

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I remember when I was district nursing. One morning I had several visits scheduled. Got caught up with one patient who was palliative and end of life who was in acute urinary retention and intense pain and nausea. As one might imagine this then lead to my next visit being late.

My next patient pretty much threw all her toys out of the cot that I was late. I apologised profusely and tried to explain without giving any details and in the end because I made this patient wait, they were going to make me wait.

What I really wanted to say was "let me tell you about my morning, i got to my previous patient who hasnt been able to pee properly for the last 8 hours and has a bladder so hard it feels like they swallowed a small pumpkin and needed an urgent catheter. Not to mention they were in so much pain and hadnt been able to eat for the last 12 hours due to nausea and has been dying slowly and painfully for the last 2 weeks. that took priority over your leg wound so harden the hell up"

What I actually said was "thats ok, I'm going to do some paperwork, you let me know when you are ready for me"

And had a damm good rant about it with my clinical manager when I got back to the office.

Patients and their families often have absolutely no idea what is going on when the nurse isn't with them. If it was me and I was able to get the PRN then and there I would happily do it. However if my patient down the hall was in urgent need of symptom relief due to being actively dying, then that takes priority. I would certainly do my best to advise the patient and their family I would be with them as soon as possible.

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We ALL know how HARD nurses work and how caring and sincere; yet, an outpouring of support for the inability to administer lo-motil including giving verbal explanation and excuse as to why it was not possible, is surprising to me. There is ALWAYS some reason for the commission of an act or it's omission, and several points of view to consider, none of which are brought up before unrelated accounts rather than investigatory questions and potential solutions...

1. diagnosis / how, if related, hospital acquired

2. dr. order / prn whether q 1, 2, 4, 6 etc. follow some pattern, related to a routine med pass

(Also, has something happened to anticipating the needs of the patient? A good rule of thumb I found was according to report and, or days post-op, chronic pain, febrile status or any number of NECESSARY reasons to RECEIVE medication is to ascertain potential need within the expected time frame, by observing and questioning the patient and referring to MAR) In the long-run it ends up being more expedient for documentation and sequentiality, as well as patient comfort and care with less random buzzer calls and interruption.)

3. dr. order/ prn, for LOOSE STOOLS, on THIS PATIENT that I feel it was important enough to hospitalize and order for...!; NOT prn for loose stools, unless something more important comes up.

I can go on about the dangers of dehydration, potential for electrolyte imbalance, intestinal bleed, parenteral fluid replacement, weakness, potential of falls, other complications...but prefer to just stop with " in the time it takes to explain to patient, family member, or physician it is easier and less stressful to give the med as timely as HUMANLY and HUMANELY possible"

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idialyze is a BSN, RN and specializes in Dialysis.

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I'm with you peachtreenurse

How hard is it to grab a couple Immodiums as soon as the patient asks? It will make the patient and family happy, and avoid big complaints later. I would like to avoid cleaning up a mess and making families angry enough to escalate their complaints up the food chain!

It takes a minute of my time and saves a lot of grief later.

Patients and families often do not think of anything beyond their own needs nowadays, some truly do not care if somebody's trying to die, they just want Mama to be taken care of.

Sometime it's easier to just go along, to get along,

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1 Follower; 6,987 Posts; 33,083 Profile Views

I'm with you peachtreenurse

How hard is it to grab a couple Immodiums as soon as the patient asks? It will make the patient and family happy, and avoid big complaints later. I would like to avoid cleaning up a mess and making families angry enough to escalate their complaints up the food chain!

It takes a minute of my time and saves a lot of grief later.

Patients and families often do not think of anything beyond their own needs nowadays, some truly do not care if somebody's trying to die, they just want Mama to be taken care of.

Sometime it's easier to just go along, to get along,

Immodium and lomotil are not the same thing. I believe that lomotil is a control.

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Glycerine82 has 4 years experience as a ASN, LPN and specializes in SNF/Rehab/Geri.

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It depends. That medication isn't exactly a critical one, and nurses give medications based on many factors. Some things we consider are giving other scheduled meds on time, whether or not the person who asked for the med already got their scheduled meds (and thus an opportunity to get the PRN) and also any other emergent or pertinent interventions/assessments/tasks etc. It also depends on whether or not the patient can have the med at the time they asked and if it can be given with meds administered prior to, etc. Another thing that comes to mind is whether or not the patient or the family were the ones to request it. We tend to wait for the patient to indicate they'd like a PRN medication and generally don't pay attention to family members who think they know what the patient needs. (unless of course, they actually do and the pt. can't speak for themselves).

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cyc0sys has 6 years experience and specializes in EMS, LTC, Sub-acute Rehab.

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If I had to wager a guess, I'd say it had to be ordered. We don't stock lomotil and it's a controlled med so you need a script from Doc. It would have been every bit of 3 hours to get it at my facility.

Cardiac, anticoagulants, respiratory, pain, and mental health drugs are prior as mandated by Law. Oxygen must go in and out. Blood must go round and round. If these drugs aren't given on time, those Patients may become an emergent very quickly.

Considering lomotil is usually given for Chronic Diarrhea related to IBS, which is a Chronic non-life threatening condition. I wonder why the Pt didn't have it on hand or the family couldn't get it from home?

All things considered, even if you're at risk for fluid/electrolyte imbalance or dehydration, you'd probably be last on my med pass if the drug wasn't on hand and the family couldn't get it.

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1,880 Posts; 21,849 Profile Views

[quote=idialyze;9897131

Patients and families often do not think of anything beyond their own needs nowadays, some truly do not care if somebody's trying to die, they just want Mama to be taken care of.

Sometime it's easier to just go along, to get along,

Yup, exactly what I was going to say.other people could care less even if there was a code blue going on.

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3 Followers; 4,776 Posts; 36,698 Profile Views

Nurses work their behinds off and do not appreciate being second guessed by patients and/or families. Agree with other posters that nurses do not make patients wait for no good reason, it just is not logical, why would anyone do that. If you are a family member of a patient, or a coworker (who is not a nurse) then please try to understand the situation. Nurses are spread very thin and need to continually prioritize ALL patient needs through out the entire shift so yes, prn's can get bumped back, and possibly a few times. Most nurses are on top of all the patient's situations but since we are human beings it is also possible that s/he plain ole forgot. Give s/he a break! (And, just in case you are the nurse and the one dealing with the patient/family, it is not your fault they had to wait, and get used to it because it happens all the time, the nurse gets blamed for everything!)

Not all nurses are overworked or as totally devoted as you expressed.

I do know that communication is key. The nurse needed to explain that she needed to get a doctor's order for Lomotil, the Lomotil wasn't due til _____, she had to assess someone who had fallen or ___________ whatever emergency the OP had not seen and did not know about, etc.

Communication can stave off a lot of problems.

And please don't expect the pt to understand or care that nurses are spread too thin or understand about prioritizing. All they really know is that their loved one is in pain and seems to be forgotten or ignored.

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3 Followers; 4,776 Posts; 36,698 Profile Views

I'm with you peachtreenurse

How hard is it to grab a couple Immodiums as soon as the patient asks? It will make the patient and family happy, and avoid big complaints later. I would like to avoid cleaning up a mess and making families angry enough to escalate their complaints up the food chain!

It takes a minute of my time and saves a lot of grief later.

Patients and families often do not think of anything beyond their own needs nowadays, some truly do not care if somebody's trying to die, they just want Mama to be taken care of.

Sometime it's easier to just go along, to get along,

It can be really hard, as many people have already stated. I agree with you in theory, but it just isn't always practical.

But it is vital to communicate with the patient/family as to why they are having to wait.

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3 Followers; 4,776 Posts; 36,698 Profile Views

If I had to wager a guess, I'd say it had to be ordered. We don't stock lomotil and it's a controlled med so you need a script from Doc. It would have been every bit of 3 hours to get it at my facility.

Cardiac, anticoagulants, respiratory, pain, and mental health drugs are prior as mandated by Law. Oxygen must go in and out. Blood must go round and round. If these drugs aren't given on time, those Patients may become an emergent very quickly.

Considering lomotil is usually given for Chronic Diarrhea related to IBS, which is a Chronic non-life threatening condition. I wonder why the Pt didn't have it on hand or the family couldn't get it from home?

All things considered, even if you're at risk for fluid/electrolyte imbalance or dehydration, you'd probably be last on my med pass if the drug wasn't on hand and the family couldn't get it.

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IBS is also painful. That picture is not funny IMHO. It shows how little you seem to care.

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